Key result
Transvenous CS lead placement improves functional capacity and narrows QRS duration by ~24 ms in D-TGA.
Why the study?
Cardiac resynchronization therapy for systemic right ventricular dysfunction in D-TGA after atrial switch operations usually requires repeat sternotomy for epicardial lead placement.
Does transvenous coronary sinus lead placement provide a feasible, less-invasive method for cardiac resynchronization therapy to improve functional capacity and surrogate markers in a patient with D-TGA, prior atrial baffle, and systemic right ventricular failure?
Case Report (n=1)
Does transvenous coronary sinus lead placement provide a feasible, less-invasive method for cardiac resynchronization therapy to improve functional capacity and surrogate markers in a patient with D-TGA, prior atrial baffle, and systemic right ventricular failure?
Cardiac CT-guided transvenous coronary sinus lead placement is anatomically feasible in select D-TGA patients with prior atrial baffle operations, eliminating the need for repeat sternotomy for CRT.
May allow transvenous CRT in D-TGA after atrial switch without sternotomy; hypothesis-generating, needs prospective validation.
BACKGROUND: Cardiac resynchronization therapy for systemic right ventricular dysfunction in D-transposition of the great arteries (D-TGA) and atrial switch operations usually require repeat sternotomy for epicardial lead placement. CASE SUMMARY: We report findings in a 33-year-old woman who underwent D-TGA and atrial baffle surgery with dual-chamber pacemaker implantation who developed progressive systemic right ventricular failure (ejection fraction: 19%) with high ventricular pacing burden. Cardiac computed tomography identified feasible coronary sinus anatomy draining into the systemic venous atrium, enabling a transvenous approach. At 12-month follow-up, she demonstrated enhanced functional capacity, reduced N-terminal pro-B-type natriuretic peptide, and narrower QRS duration. DISCUSSION: We report the first successful transvenous coronary sinus lead placement in a patient with prior atrial baffle surgery, highlighting the importance of imaging in assisting procedural planning. TAKE-HOME MESSAGE: Imaging in the setting of D-TGA patients with right ventricular dysfunction may identify accessible coronary sinus anatomy, eliminating the need for repeat sternotomy while providing cardiac resynchronization therapy benefits.
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Reyes et al. (2025) conducted a case report in Systemic right ventricular dysfunction in D-transposition of the great arteries (D-TGA) (n=1). Transvenous coronary sinus lead placement for cardiac resynchronization therapy was evaluated on Clinical, functional, and echocardiographic response. Transvenous coronary sinus lead placement in a D-TGA patient with prior atrial baffle surgery resulted in enhanced functional capacity, narrowed QRS duration by 24 milliseconds, and decreased NT-proBNP from 396 to 131 pg/mL at 12 months.
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